Flexures Hyperpigmentation

Hyperpigmentation in the flexures

Flexural hyperpigmentation is usually racial but may be due to acanthosis nigricans and pseudoacanthosis nigricans particularly in fat individuals.  Erythrasma gives a reddish brown patch in the axillae or groin and some tinea infections in the groin do the same thing.Freckling in the axillae is one of the features of neurofibromatosis type 1.(Crowe's sign)

Other rarer diseases   Gougerot Carteaud syndrome,Lentiginosis profusa,Xeroderma pigmentosum,Darier's disease,Haber's syndrome,Kitamura's acropigmentation,Dowling Degos disease(Axillae)

SIGN DIP MEN  Overview of Hyperpigmentation

 S-Squamous   Resolved lichen planus

 

I-Infective  Rarely leishmaniasis

 

G-Granulomatous

 

N-Neoplastic  Melanoma metastases,Lung carcinoma,Lymphoma

 

D-Drugs   Melasma, Fixed drug eruption,bleomycin,arsenic,gold and cyclophosphamide,PuvaClofazimine

 

I-Immunological Scleroderma,lupus erythematosus and dermatomyositis

 

P-Physical  Post sunburn,Post taumatic,Racial pigmentary demarcation lines,Phototoxic hyperpigmentation (Plants),Vagabond’s disease

 

M-Metabolic  Addison’s disease,Porphyria cutanea tarda,Hemochromatosis,Renal and hepatic failure,Amyloidosis

 

E-Endocrine  Hyperthyroidism,Pregnancy,Cushings,Acromegally,Thyrotoxicosis,Pheochromocytoma

 

N-Nutritional  Pellagra,Malabsorption

 

Others

Eyelids  Familial,nevoid,metabolic diseases such as ochronosis,chemical such as mercury ointments and psoralens and argyria,lichen planus,lichen aureus,melanoacanthoma and some endocrine diseases.

Reticulate Pigmentation  Dowling Degos(flexures),Zosteriform,Dyskeratosis congenita,Naegeli Franceschetti syndrome(neck axillae,keratoderma),Acropigmentations of Kitamura and Dohi

 

Localised hyperpigmentation  DAMN PIG PAPA

 

Drugs Fixed drug plus antimalarials,minocycline,cytotoxics,bleomycin(reticulate pigmentation),mercury and bismuth.

Autoimmune Scleroderma,lupus erythematosus,dermatomyositis,atrophoderma,

Metabolic Ochronosis,chloasma,gaucher's disease,

Neoplastic Lymphoma,melanoma,mastocytosis,

P erythema dyschromicum perstans,postinflammatory hyperpigmentation lichen planus,

Infective erythrasma,tinea nigra

Granulomatous leprosy,granuloma annulare,syphilis

P Parapsoriasis,A Amyloid,P Pigmented purpuric dermatosis,A acanthosis nigricans